From the Guidelines
Iron infusions rarely cause liver failure, and when they do, it is often due to excessive iron accumulation in the body, rather than the infusion itself. While iron infusions can cause side effects like allergic reactions, pain at the injection site, headaches, and nausea, liver failure is not a common complication 1. However, excessive iron accumulation in the body (iron overload) can potentially damage the liver over time, typically occurring in people with hereditary hemochromatosis or those receiving multiple transfusions, rather than from properly administered therapeutic iron infusions 1.
Some key points to consider:
- Iron infusions are generally safe when given at appropriate doses under medical supervision 1.
- Healthcare providers monitor iron levels before and after treatment to prevent overload 1.
- If you're receiving iron infusions, report any unusual symptoms like severe abdominal pain, yellowing of skin or eyes, or extreme fatigue to your doctor immediately 1.
- The liver normally stores iron and regulates its metabolism, but when overwhelmed by excessive iron, cellular damage can occur through oxidative stress mechanisms, potentially leading to fibrosis or cirrhosis in severe cases 1.
In terms of specific guidelines, the most recent study recommends that iron infusions be used when oral iron supplementation is not effective or tolerated, and that formulations that can replace iron deficits with 1 to 2 infusions are preferred 1. Additionally, being truly allergic to IV iron is very rare, and most reactions are complement activation–related pseudo-allergy, which are idiosyncratic infusion reactions that can mimic allergic reactions 1.
Overall, while iron infusions are generally safe, it is essential to monitor iron levels and report any unusual symptoms to prevent potential complications, including liver damage. The benefits of iron infusions in treating iron deficiency anemia outweigh the risks, and with proper medical supervision, the risk of liver failure can be minimized.
From the FDA Drug Label
INFeD should be used with extreme care in patients with serious impairment of liver function. The FDA drug label suggests that iron dextran (IV) should be used with caution in patients with liver function impairment, but it does not directly state that iron infusions can cause liver failure 2.
- The label warns of potential risks in patients with underlying conditions, including those with serious impairment of liver function.
- However, it does not provide explicit information on the risk of liver failure associated with iron infusions.
From the Research
Iron Infusions and Liver Failure
- Iron infusions can lead to iron overload, which is toxic to the liver and can cause liver failure 3, 4.
- The liver is a major site of iron storage and is particularly susceptible to injury from iron overload, especially when iron accumulates in hepatocytes 4.
- Chronic hepatic iron overload can cause fibrosis, cirrhosis, and hepatocellular carcinoma, and can also contribute to the development or progression of other liver diseases such as alcoholic liver disease, nonalcoholic liver steatohepatitis, and chronic viral hepatitis 3, 5.
Mechanisms of Iron-Induced Liver Injury
- Iron overload can increase oxidative stress and lysosomal lability, leading to liver damage 4.
- Iron can also potentiate coexisting inflammation, leading to hepatocyte necrosis and fibrogenesis 6.
- The production of hepcidin, a key protein in iron metabolism, is decreased in chronic liver disease, leading to iron overload and liver damage 5.
Clinical Evidence
- A study of intravenous iron infusion in a gastroenterology day hospital found no adverse effects, but patients with liver cirrhosis had higher iron and transfusion requirements and mortality 7.
- Another study found that iron overload is only weakly fibrogenic in animal models and rarely causes serious liver damage in humans, suggesting that iron overload may not be as important a cause of hepatotoxicity as previously thought 6.